Introduction

Each year, oral cancer kills more people in the US than does cervical cancer, malignant melanoma, (1) or Hodgkin’s disease. Oral cancers usually involve the tongue, lips, floor of the mouth, soft palate, tonsils, salivary glands, or back of the throat (oropharynx). In the US , more than 90% of oral and oropharyngeal cancers occur in individuals over 45 years of age; males are more likely than females to develop (1,2) them (see Chapter I). The primary risk factors for oral cancers in this country are tobacco and (3-6) alcohol use; HPV16 for tonsil and base of tongue cancers, for lip cancer exposure to the sun is most important (see Chapter III). Advanced oral cancer and its sequelae cause chronic pain, loss of function, and irreparable, socially disfiguring impairment. The functional, cosmetic, and psychological insults suffered by oral cancer patients often result in social isolation, significantly burdening patients, their families and society. (7)

Of all the procedures available to control oral cancer, none has affected survival as much as has early (3) detection. Unlike other parts of the body, the oral cavity is easily accessible and an oral cancer examination poses relatively little discomfort or embarrassment for the patient. Dentists are the provider of choice to perform oral cancer examinations, but the Registered Dental Hygiene (RDH) community has taken a strong position to become oral cancer screeners, and conduct a large number of the in dental offices screenings at this time. But about 40% of the population does not (8) visit a dentist in a given year. Furthermore, those who are middle age or older, edentulous, of lower income status, black or Hispanic-the groups at highest risk for oral cancers-are even less likely to (9) visit a dentist. Thus, other health care providers must assume more responsibility to ensure that the public receives oral cancer examinations on a routine basis. Primary care physicians should know that targeting those at high risk is a viable and cost-effective intervention for oral cancer when performed (10-12) as part of routine practice. Oral cancer examinations also offer providers an opportunity to identify patients who use tobacco and alcohol and counsel them about their risk for cancers. (13, 14) A novel approach to self examination, self discovery, and self referral to a dental professional has been introduced by the Oral Cancer Foundation (www.oralcancer.org) a national non profit charity. (www.checkyourmouth.org)

Oral cancer has one of the lowest 5-year survival rates of all major cancers, probably because most (15) lesions are not diagnosed until they are advanced. However, when detected early, the probability (16) of surviving from oral cancer is remarkably better than for most other cancers. Theoretically, morbidity and mortality due to oral cancers can be reduced dramatically with appropriate interventions; because of this potential, 13 of the objectives in Healthy People 2000 relate to oral cancer prevention and early detection (Table 1). (17) To achieve these objectives, health care providers and the public need to know the risk factors for oral cancer, as well as their signs and symptoms. Furthermore, health care providers, particularly dentists, physicians, nurse practitioners, nurses and dental hygienists, need to provide oral cancer examinations routinely and competently. Equally important, members of the public need to know that an examination for oral cancer is available and that they can request one routinely. Thus, both health care providers and the general public need to increase their knowledge and change their behaviors or practices. Health promotion is a key to achieving these changes.

Table 1:

Healthy People Oral Cancer Objectives(17)

2.2 Reverse the rise in cancer deaths to achieve a rate of no more than 130 per 100,000 people.

2.6 Increase complex carbohydrates and fiber containing foods in the diets of adults to 5 or more daily servings for vegetables (including legumes) and fruits, and to 6 or more daily servings for grain products. 3.4 Reduce cigarette smoking to a prevalence of no more than 15% among people aged 20 and older.

3.5 Reduce the initiation of cigarette smoking by children and youth so that no more than 15% have become regular cigarette smokers by age 20.

3.9 Reduce smokeless tobacco use by males aged 12 through 24 to a prevalence of no more than 4%.

3.16 Increase to at least 75% the proportion of primary care and oral health care providers who routinely advise cessation and provide assistance and followup for all of their tobacco-using patients.

4.6 Reduce the proportion of young people who have used alcohol, marijuana and cocaine in the past month.

4.7 Reduce the proportion of high scho